<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">医生:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-user_id" data-rule="required" data-source="user/doctor/index" data-field="nickname"
                data-format-item="{nickname}（{mobile}）" data-params='{"custom[role]":"30"}'
                class="form-control selectpage" name="row[user_id]" type="text" value="">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">检测项目:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-order_goods_id" data-multiple="true" data-rule="required" data-source="goods/goods/index"
                data-field="title" data-format-item="{title}（{goods_no}）" class="form-control selectpage" name="row[goods_ids]" type="text" value="">
        </div>
    </div>
    <div id="rongqiview">
        
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Username')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-username" class="form-control" data-rule="required" name="row[username]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Userphone')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-userphone" class="form-control" name="row[userphone]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Age')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-age" class="form-control" data-rule="required" name="row[age]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Gender')}:</label>
        <div class="col-xs-12 col-sm-8">
            <!-- <input id="c-gender" class="form-control" data-rule="required" name="row[gender]" type="text"> -->
            <select name="row[gender]" id="c-gender" class="form-control" value="男">
                <option value="男">男</option>
                <option value="女">女</option>
            </select>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">&nbsp;</label>
        <div class="col-xs-12 col-sm-8" >
            共计: <span id="total" style="color: #ff0000;">0</span> 元
        </div>
    </div>

    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>